Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment
Norbert Harrasser, Ingo J Banke, Matthias Hauschild, Ulrich Lenze, Peter M Prodinger, Andreas Toepfer, Christian Peschel, Rüdiger Von Eisenhart-Rothe, Ingo Ringshausen & Mareike Verbeek
abstract
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BACKGROUND
Mucormycosis is an invasive mycotic disease caused by fungi in the
zygomycetes class. Although ubiquitous in the environment,
zygomycetes are rarely known to cause invasive disease in
immunocompromised hosts with a high mortality even under aggressive
antifungal and surgical therapy. Clinically, mucormycosis frequently
affects the sinus occasionally showing pulmonary or cerebral
involvement. However skeletal manifestation with Rhizopus
microsporus (RM) osteomyelitis leading to emergency surgical
proximal femoral resection with fatal outcome has not been described
yet.
CASE PRESENTATION
We report the case of a 73-year-old male suffering from
myelodysplastic syndrome with precedent bone marrow transplantation.
Six months after transplantation he consulted our internal medicine
department in a septic condition with a four week history of painful
swelling of the right hip. Radiography, computed tomography and
magnetic resonance imaging revealed multiple bone infarcts in both
femurs. In the right femoral head, neck and trochanteric region a
recent infarct showed massive secondary osteomyelitis, breaking
through the medial cortex. Emergency surgical proximal femoral
resection was performed due to extensive bone and soft tissue
destruction. Microbiological and basic local alignment search tool
(BLAST) analysis revealed RM. Amphotericin B and posaconazole
treatment with septic revision surgery was performed. However the
disease ran a rapid course and was fatal two months after hospital
admission.
CONCLUSION
This alarming result with extensive RM osteomyelitis in the proximal
femur of an immunocompromised patient may hopefully warn medical
staff to perform early imaging and aggressive surgical supported
multimodal treatment in similar cases.
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citation
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Harrasser N, Banke I J, Hauschild M, Lenze U, Prodinger P M, Toepfer
A, Peschel C, von Eisenhart-Rothe R, Ringshausen I, Verbeek M.
Clinical challenge: fatal mucormycotic osteomyelitis caused by
Rhizopus microsporus despite aggressive multimodal treatment. BMC
Infect Dis 2014; 14:488.
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type
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journal paper/review (English)
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date of publishing
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06-09-2014
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journal title
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BMC Infect Dis (14)
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ISSN electronic
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1471-2334
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pages
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488
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PubMed
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25195155
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DOI
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10.1186/1471-2334-14-488
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